Induction of labour in Singapore: why it's offered, how it's done and what happens on the day

Induction of labour means your doctor starts labour for you instead of waiting for it to begin. In Singapore, KKH offers it for reasons like gestational diabetes, high blood pressure, a baby who isn't growing well or an overdue pregnancy, and the aim is a vaginal birth. After checking your cervix, the team uses a pessary, a balloon, breaking your waters or a drip, alone or together. SGH says about 6 to 7 in 10 inductions end in a vaginal birth.

How induction of labour works, step by step

1. Ask your gynae why they're suggesting it and what waiting would mean. The NHS says it's your choice whether to be induced.
2. Ask which method they'll start with and where. KKH does inductions in its Obstetric Monitoring Unit (Women's Tower, Level 3) or its Delivery Suite (Level 2).
3. Eat a meal before your appointment, as KKH asks; once you're in labour, NUH's rule is no food and sips of water only.
4. Pack your documents with your hospital bag. KKH asks for your antenatal appointment booklet, your and your husband's IC or passport, and the inpatient admission authorisation form.
5. Check in at the place on your letter: at KKH, the Admissions Office on Level 1 of the Women's Tower or the Delivery Suite on Level 2.
6. Let the doctor examine your cervix first, since at KKH and SGH that check decides which method you get.
7. Rest while the pessary or balloon works. KKH says a balloon stays in for about 12 hours and a pessary releases its medicine over 12 to 24 hours, with you and your baby monitored.
8. Tell the midwife if contractions feel too strong or close together, since KKH says a small number of women are very sensitive to the medicine.
9. Plan your pain relief early with your gynae: SGH offers laughing gas, opioid painkillers and an epidural, and our epidural guide compares them.
10. Once labour is established, expect a CTG monitor on your bump for your baby's heartbeat and your contractions. SGH reviews you about every 4 hours.

Why your gynae may suggest an induction

KKH lists the most common reasons. They are a condition like gestational diabetes or high blood pressure, a baby at risk from growth restriction or an abnormality, and an overdue pregnancy. SGH adds waters that break before labour after 34 weeks, and conditions such as chronic hypertension, diabetes or autoimmune disease. The NHS also names intrahepatic cholestasis of pregnancy, a liver condition.

For an overdue baby, the NHS offers induction if labour hasn't started by 41 weeks. Ask your gynae which week they use. Our 40 weeks pregnant guide covers going past your due date. For the membrane sweep you may be offered first, see how to start labour naturally, and if induction comes up earlier for a medical reason, the 33 weeks pregnant guide has a short overview.

Some pregnancies aren't suited to induction. ACOG says it's usually avoided when the placenta covers the cervix, or when the baby is breech or lying sideways; see breech baby in Singapore. If you've had a caesarean, ACOG says some prostaglandins aren't used. VBAC in Singapore explains how hospitals handle labour after a scar.

The methods, and what each one involves

Before choosing, your doctor checks your cervix with a vaginal examination. ACOG says doctors may give it a Bishop score from 0 to 13, and a score under 6 means your cervix may not be ready for labour. A cervix that isn't ready is softened first, which doctors call ripening.

The NHS says the hormone can also come as a gel, or as tablets you swallow, and is usually tried first. Which version you get depends on your hospital and your doctor.

How long induction of labour takes

There's no single figure. KKH says the time varies because every woman responds differently. Softening alone can take 12 to 24 hours with a pessary, or about 12 hours with a balloon, before your waters are broken or a drip is started. The NHS says these treatments usually take many hours to start working.

Once your waters are broken, ACOG says most women go into labour within a few hours, though some also need the oxytocin drip. Bring a phone charger and something to pass the time. The NHS suggests walking or moving about in early labour if you feel like it, so ask your midwife when you can get up.

Expect a hospital stay. KKH's unit monitors you and your baby until you go into labour. The NHS says you may be able to go home during an induction in some cases, so ask your gynae whether that's an option where you deliver.

Induced labour vs natural labour

SGH says induced labour can be longer and more painful than labour that starts on its own. The NHS says you're also more likely to need an assisted delivery with forceps or ventouse suction. Our guide to forceps and vacuum delivery explains how that works.

Your pain relief choices stay the same. The NHS says they aren't restricted by being induced. SGH can arrange a talk with an obstetric anaesthetist if you have concerns, and NUH suggests you discuss options with your obstetrician before the birth.

Once you're in established labour, our guide to the stages of labour walks through what happens next.

If the induction doesn't work

KKH says most mothers go into labour with one of these methods. If you don't, the team checks your cervix again and makes a new plan. If your cervix doesn't soften, KKH says you may be offered another method or a caesarean.

The NHS says you may be able to wait a few hours and be checked again. ACOG says that if you and your baby are well and your waters haven't broken, you may be offered the option to go home and come back for another try. Go back to the hospital if labour starts; our contraction timer helps you time it. For what a caesarean involves, see C-section vs normal delivery.

When to see a doctor

Before your induction date, or if you're sent home to wait, go to your delivery hospital straight away if you notice any of these:

• Your baby moving less than usual. KKH asks you to come to its Delivery Suite, so don't wait for your induction date or next check-up. Our baby kick counter helps you keep track.
• Vaginal bleeding. SGH says bleeding as heavy as a period means going straight to hospital, and NUH asks you to come in for any bleeding that isn't a show.
• If your waters break before your induction date, SGH says to go straight to hospital because of the risk of infection for you and your baby.
• Waters that aren't clear and pale, such as green or brown fluid, or that smell. The NHS says coloured or smelly waters could mean you and your baby need urgent attention. Wear a pad, not a tampon, so the colour can be checked.
• A fever, a severe headache, changes in your vision, or tummy pain. KKH lists these as reasons to come in, and SGH names high blood pressure with a headache or blurred vision.
• Contractions that feel too strong or too close together while you're being induced. Tell your midwife. ACOG says the drip may be turned down or stopped if your baby's heart rate changes.

Where to go: KKH's Delivery Suite is on Level 2 of the Women's Tower, from 22 weeks. SGH's Labour Ward 52A is at Block 5, Level 2, open 24 hours, from 20 weeks; its midwife line is 6321 4520. NUH's Delivery Suite is Ward 22, Main Building, Level 2. With a private gynae, call their clinic and go to the hospital where you're booked. KKH says to call 995 for an emergency. If your baby isn't due yet, see premature labour signs.

Frequently asked questions

What happens when you are induced?

You're admitted and your cervix is checked. The team then uses a pessary, a balloon, breaking your waters or an oxytocin drip to start labour, and you and your baby are monitored. At KKH this happens in the Obstetric Monitoring Unit or the Delivery Suite.

How long does induction of labour take?

It depends on your cervix. KKH says a pessary works over 12 to 24 hours and a balloon over about 12, and that every woman responds differently. SGH says induced labour can also be longer than labour that starts on its own.

Can I ask for induction at 39 weeks?

ACOG, the US college of obstetricians, says elective induction shouldn't happen before 39 weeks. It says induction may be considered for healthy women at 39 weeks to lower the chance of a caesarean. That's US guidance, so ask your gynae what they offer.

Induced labour vs natural labour: which is harder?

SGH says induced labour can be longer and more painful, and the NHS says you're more likely to need forceps or ventouse. An epidural and every other kind of pain relief are still open to you.

Is induction of labour safe for my baby?

KKH says a membrane sweep and breaking the waters won't harm your baby. The risks it names are a cervix that doesn't soften, which can mean another method or a caesarean, and contractions that come too often or too strongly. ACOG says monitoring your baby's heart rate during induction helps prevent complications.

Can I say no to an induction?

Yes. The NHS says it's your choice, and that past 42 weeks without an induction you should be offered extra monitoring. Ask your gynae what waiting would mean for you and your baby.